The Local Infectious Disease Forecasting Station: "Partly Cloudy With A Chance Of Vomiting"

"Game On": we are now in a new era of operational biosurveillance, specifically the routinization or socialization of infectious disease forecasting such that local communities around the world become used to, and expect, access to highly detailed infectious disease forecasting information.

The intent of this blog is to promote a vision for the world.  The vision of infectious disease forecasting and promotion of better situational awareness that is relevant to the daily public.  Certainly we discuss controversial world issues such as biodefense, biological warfare, bioterrorism, genetic engineering, and so on, but at the end of the day people continue to lead their daily lives as they should.  This is not to say these high level issues are not worthy of costing a few analysts' their sleep, but national security begins at the local community level with the promotion of resilience.

This was the lesson we learned in Haiti, where engagement of local Haitians provided awareness of the introduction of cholera, which was later labeled by the Haitian government as a national security issue.  Either way it could be argued such an accident might have eventually occurred anyway given the flow of humanitarian traffic to this extremely vulnerable area of the world.  The point is if forecasts hadn't been issued by the HEAS, and a social network representative of an invested community that included local Haitians hadn't rallied together around those forecasts and situational awareness, they would not have been primed to recognize non-routine infectious disease activity.  ...And display such incredibly rapid response convergence around that information.  This experience changed many of the responders' lives, including my own, and left us with an extremely strong sense of devotion to the concept of local community resilience. 

This of course sounds like an entirely different world than our current reality of forecasting routine endemic infectious disease in a rural community.  But it isn't.  What is happening is we have a tremendous demand from our patients to have access to the forecasts- down to a highly granular level of information.  Similar to the public demand for access to temperature, humidity, and air pressure readings in meteorology.  Personally, I do not fully understand the relationship between high and low barometric readings on the news and usually igore it.  I'm far more interested in whether it will rain or snow.  But we have air plane pilots, for instance, that do care about that information. 

In the world of local community infectious disease forecasting, we have the same kind of variation in patient interest in the information: 

• I have parents that want me to sit down with them and review the forecast but then want me to "keep them posted", content that their physician understands their local "health intelligence" at such a granular level and is prepared to inform them of emerging risk. 
• I also have parents who have a brittle asthmatic child whose triggers for a severe asthmatic exacerbation include respiratory viral infection and agricultural burning or forest fire smoke.  These children are so sensitive, they can rapidly require hospitalization, admission to the intensive care unit, intubation and ventilation, or transfer to a major critical care center.  We track near-real time satellite imagery so that we are able to give these parents a "heads up" with several days' advance notice of wildfire smoke that may be vectoring into the area.  This is in collaboration with the US National Oceanic and Atmospheric Administration (NOAA), and we are profoundly thankful to them for their hard work.  We also share the infectious disease forecast which multiple infectious agents we know are capable of triggering an asthmatic into exacerbation.  One of these families told me that hospitalization of their child (who is extremely sensitive to agricultural burning and wildfire smoke) is so incredibly disruptive to their family and expensive, they were inclined to pack the family into the car and leave the area until smoke had cleared if they were given a 3-day forecast.  This is of course an extreme example, but indicative of the impact these forecastable health conditions are to our clientele.
• Then I have another family that has had a horrid time with plantar warts.  All three of their kids were infected, two of whom had warts as large as 1 cm in diameter.  They came in about every two weeks to have these warts sanded and scraped down with a scapel, cryofrozen, and treated with canthacur.  It took multiple treatments, each about 30 minutes in the clinic.  This seemingly insignificant example was, however, quite significant to this family who had certainly better things to do with their time and wanted to avoid another occurence.  So they asked about a forecast for plantar warts along with guidance for how to avoid exposure, which we provided.
• And then we have yet another family whose child is immunocompromised and runs around with face mask on.  They worry about taking her to the local grocery store or the movies when there is high infectious disease activity.  So they are keenly interested in the detailed, line by line forecast.

I often reflect on Haiti and the heartbreaking misery and heart-warming joy of the people there and remember my time with them as we move forward in rural America.